Displacement and Mental Illness in African Countries
An insight into the concept of ‘internally displaced people’
Years ago, the former United Nations Secretary General, Kofi-Annan, mentioned something very thoughtful about internal displacement. He said, “Internal displacement is the great tragedy of our time. The internally displaced people are among the most vulnerable of the human family” (quoted in UNOCHA, 1998). So, who are internally displaced people? As the Guiding Principles on Internal Displacement described, “internally displaced persons (also known as "IDPs") are persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized border” (1998, quoted in IDMC, 2013-2018). Attention need to be paid when the question of refugees comes. As opposed to internally displaced people, refugees do cross international boundaries. Additionally, United Nations Human Rights Office of the High Commissioner (OHCHR) stated, “unlike refugees, these internally displaced persons do not have a special status in international law with rights specific to their situation. The term internally displaced person is merely descriptive” (OHCHR, 1996-2018).
Displacement and Mental Health
Stress level increases dramatically when faced with conflict and massive displacement and thereby, leads to severe distortion of mental health. Global Burden of Disease (GBD) studies stated that conflict is strongly linked to depression and anxiety disorders (2015, quoted in Marquez, 2016).
The numbers are staggering
As of 2015, the total number of people displaced by conflict in the sub-Saharan Africa was almost 12 million and over 1 million people were displaced due to natural disasters. (Owoaje et al., 2016).
2016 data is as follows:
| NEW DISPLACEMENT ASSOCIATED WITH CONFLICT AND DISASTERS IN 2016 (AFRICA) | ||
| Type of Displacement | Number of population (Total) | |
| Conflict and violence | 2.8 million | |
| Disaster | 1.1 million | |
| Country | Conflict | Disasters |
| Libya | 156,000 |
|
| Niger | 166,000 | 46,000 |
| Senegal |
| 24,000 |
| Chad | 36,000 |
|
| Nigeria | 501,000 | 78,000 |
| Cameroon | 83,000 |
|
| Central African Republic | 46,000 |
|
| Republic of the Congo | 25,000 |
|
| Democratic Republic of the Congo | 922,000 | 130,000 |
| Tanzania |
| 36,000 |
| Madagascar |
| 51,000 |
| Uganda | 23,000 |
|
| Kenya |
| 40,000 |
| South Sudan | 281,000 |
|
| Ethiopia | 296,000 | 347,000 |
| Somalia | 113,000 | 70,000 |
| Sudan | 97,000 | 123,000 |
(IDMC & NRC, 2017)
2018 Data is as follows:
| NEW DISPLACEMENT ASSOCIATED WITH CONFLICT AND DISASTERS IN 2018 (SUB-SAHARAN AFRICA) | |||
| Country | Conflict | Disasters | Time Length |
| Angola |
| 5,400 | Jan - 5 Mar |
| Central African Republic | 11,630 |
| 7 Feb – 5 Mar |
| Democratic Republic of the Congo | 32,000 |
| 10 Feb - 6 Mar; about 19,000 returns between Jan - 6 Mar |
| Kenya | 2,400 | 1 Feb – 8 Mar | |
| South Sudan | 7,600 (Conflict and Development) |
| 11 - 23 Feb |
(IDMC, 2018)
In a conflict scenario, depression, anxiety, and post-traumatic stress disorders (PTSDs) increases from 10% to 15-20% and a much graver or acute mental disorder such as psychosis can have an increment from 1-2 % to 3-4 % (Marquez, 2016).
It’s a vicious circle: the association of mental diseases and non-communicable diseases
Apart from increasing the burden of communicable diseases, displacement due to conflict, also has dire impact on non-communicable diseases. Common mental diseases like post-traumatic stress disorders (PTSDs), anxiety disorders, depression are the outcomes of such displacement. But problems don’t end here as the impacts are manifold. These disorders lead to significant change in peoples’ behaviour. It is easy for a mentally disturbed or depressed person, who has lost everything to the conflict in his/her country, to develop habits (such as physical inactivity, smoking, heavy consumption of alcohol, eating the wrong kind of food etc) which are conducive to developing non-communicable diseases such as cardiovascular disease, diabetes, hypertension, cancer, obesity and many more. Non-communicable disease by itself can also lead to mental diseases, though the consequences are much severe in the case of displacement (Marquez, 2016).
A holistic approach for prevention and management of mental diseases
This approach need to be blended well with the preventive and management mechanism of physical diseases as we know non-communicable diseases and mental diseases are positively associated. In an article, written by Marquez and Walker, they talk about five essential and effective approaches of prevention and management mechanism of mental diseases, to be incorporated along a mental health value chain at community and facility levels. These approaches are, prevention, which focuses on minimization of community stigma; second approach is case finding, which is psychological assessment and diagnosis; treatment - counselling and medications; follow-up approach is symptom assessment and lastly reintegration which is social and economic interventions (Marquez and Walker, 2016).
Lastly...
It is evident that the benefits reaped from investing in mental health for conflict-affected population are highly positive. Reintegrating these people into the economy would not only be the gain of one government, but the global nation as a whole.
Reference
Internal Displacement Monitoring Centre (IDMC) (2013-2018) What is Internal Displacement. Available at: http://www.internal-displacement.org/internal-displacement/what-is-internal-displacement/ (Accessed: 11 April 2018).
IDMC (2018) Internal Displacement Update. Available at: http://www.internal-displacement.org/internal-displacement-updates/issue-31-8-february-7-march-2018?ref=hp (Accessed: 12 April 2018).
IDMC & Norwegian Refugee Council (NRC) (2017) Africa Report on Internal Displacement.
Marquez, P. and Walker, M. (2016) Mental health services in situations of conflict, fragility and violence: What to do? Available at: https://blogs.worldbank.org/health/mental-health-services-situations-conflict-fragility-and-violence-what-do (Accessed: 9 April 2018).
Marquez, P. (2016) Mental health among displaced people and refugees: Making the case for action at the World Bank Group. Washington, D.C.: World Bank Group. Available at: http://documents.worldbank.org/curated/en/441551482228026197/Mental-health-among-displaced-people-and-refugees-making-the-case-for-action-at-the-World-Bank-Group (Accessed: 11 April 2018)
Owoaje, E., Uchendu, O., Ajayi, T., and Cadmus, E. (2016) ‘A Review of the Health Problems of the Internally Displaced Persons in Africa’, Nigerian Postgraduate Medical Journal, 23(4), 161-171. doi: 10.4103/1117-1936.196242
United Nations High Commissioner for Refugees (UNHCR) (2018) Internally Displaced Persons. Available at: http://www.refworld.org/idps.html (Accessed: 11 April 2018).
United Nations Human Rights Office of the High Commissioner (OHCHR) (1996-2018) Questions and Answers about IDPs. Available at: http://www.ohchr.org/EN/Issues/IDPersons/Pages/Issues.aspx (Accessed: 9 April 2018).
United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) (1998) Guiding Principles of Internal Displacement.